Ask Nurse Practictioner Ila Shebar: Safety of testosterone for women not known

While there has been some research documenting its effectiveness, there hasn't been enough to demonstrate either that or its long-term safety.

Ila Shebar is a women's health nurse practitioner specializing in women's pelvic health and continence at Pioneer Valley Urology in Springfield. Her "Ask Ila" column appears every other Wednesday in the Health & Science section of The Republican and on MassLive.com. She can be reached at ilashebarnp.pvu@gmail.comThe Republican file

By ILA SHEBAR

Will taking testosterone increase my sex drive? I’ve been reading about it but I am not clear on the answer.

Well, neither am I. Some research has shown that the hormone testosterone does effectively boost sex drive in some women with sexual dysfunction, but the long-term safety of testosterone therapy for women is unknown. I myself am not yet prescribing it for my patients for this reason.

Hormones are substances secreted by tissues in your body that then travel to have an effect on other tissues in your body. Many hormones have effects on both growth of reproductive tissues and on your behavior.

Testosterone, one of the male sex hormones called androgens, is not unique to men but is present in women also. It is produced and released into your system by your ovaries and adrenal glands.

The release of the hormone varies daily, from moment to moment, and changes depending on where you are in your menstrual cycle. Testosterone levels in women peak mid cycle, are highest when they are in their 20s, and may be used in the evaluation of infertility, hirsutism (excess hair growth in women), and infertility.

Testosterone in women may have a direct effect on sex drive and sexual response. Some women taking testosterone have reported more sexual thoughts, fantasies, activity and satisfaction.

But there are no studies that have reported solid links between high testosterone in women and high sex drives or low testosterone levels and low sex drives. This is what makes treatment controversial. You could have high levels and a low sex drive or vice versa. You could have high or low levels of testosterone but have normal sexual desire.

Regardless of your testosterone levels, there are other factors that may affect postmenopausal sexual dysfunction including decreased estrogen levels, vaginal dryness, medication side effects and chronic health conditions. Emotional or psychological factors may include loss of a spouse or partner, lack of emotional intimacy, conflict, stress or mood concerns.

High levels of testosterone have been linked to polycycstic ovary syndrome, or PCOS, and can lead to infertility. It also can lead to baldness, acne, a deeper voice, an enlarged clitoris and increased muscle mass.

Your question relates to the decline in testosterone that is thought to occur at menopause. This decline may be associated with a decreased libido. But so many other things can have an effect on a woman’s libido that it is not so simple to evaluate.

There is some thought that testosterone replacement may help restore sexual functioning in perimenopausal and menopausal women. This therapy is not FDA-approved for women, though, and should be initiated with caution.

There is no testosterone patch or cream produced for women. All current testosterone products are made for treating men; they are transdermal, intramuscular injection, or implanted subcutaneously. If it is prescribed for women, it is done so “off label” and most likely needs to be compounded, as the doses available for men are too high for women.

Off-label use of testosterone is sometimes prescribed to improve sexual desire in menopausal women. Women with low arousal or sexual satisfaction may be treated with testosterone.

Low testosterone levels may be found in women who have had their ovaries remove. For these women, use of testosterone replacement along with estrogen replacement has been shown to improve feelings of sexual desire.

Low levels may also be found in women with an underactive pituitary gland or a problem with their adrenal system. It should not be used at all in women with breast or uterine cancer.

Use of testosterone for young pre-menopausal women is very controversial. Testosterone should not be used during pregnancy, either, as it can affect the growing fetus. If you are sexually active and you are of the age where pregnancy can occur, you should be using birth control along with testosterone treatment.

Do not use testosterone off label treatment if you have heart disease, liver disease or high cholesterol.

As this therapy is not FDA-approved, long-term side effects of this off label treatment have not been studied. Again, there is no FDA-approved product like this for women. It is unknown whether it raises the risks of breast cancer or blood clots.

I know I haven’t answered your question, but I don’t have a good answer for it yet. While there has been some research documenting its effectiveness, there hasn’t been enough to demonstrate either that or its long-term safety.

And there are too many other contributing factors to female sexual dysfunction to make it an easy fix. You need to discuss this on an individual basis with your provider to decide if it’s an option that’s right for you to try.

Ila Shebar is a women’s health nurse practitioner specializing in women’s pelvic health and continence at Pioneer Valley Urology in Springfield. Her “Ask Ila” column appears every other Wednesday in the Health & Science section of The Republican and on MassLive .com. She can be reached at ilashebarnp.pvu@gmail.com